Ameda Kei, Yamada Yoko, Uehara Yuriko, Ohno Tamami, Hoya Mari, Oda Hiroko, Mishima Misako
Department of Obstetrics and Gynecology, Kawakita General Hospital, Tokyo, Japan.
Case Rep Obstet Gynecol. 2021 Jun 8;2021:9980015. doi: 10.1155/2021/9980015. eCollection 2021.
Streptococcal toxic shock syndrome (STSS) is a life-threatening illness mainly caused by invasive group A (GAS) infection. Herein, we report a case of a postmenopausal woman who developed STSS from an ascending vaginal GAS infection after cytocervical sampling. The patient complained of vaginal discharge, for which she underwent gynecological examination with vaginal sampling. The following day, there was onset of diarrhea and vomiting. After 7 days, she was admitted to our hospital with septic shock. Necrotizing enterocolitis was suspected and surgical intervention was performed; however, the patient was diagnosed with primary peritonitis and antibiotics were initiated. On day 2, GAS was suspected by blood cultures, and antibiotics were changed in consideration of STSS. On day 4, GAS was confirmed in blood, ascitic fluid, and vaginal swab specimens, and STSS caused by an ascending vaginal GAS infection was diagnosed. This case report indicates that STSS could occur following cytocervical sampling for vaginal discharge. If a woman has unexplained septic shock, especially with gastroenteritis symptoms, STSS should be considered as a differential diagnosis.
链球菌中毒性休克综合征（STSS）是一种主要由侵袭性A组（GAS）感染引起的危及生命的疾病。在此，我们报告一例绝经后女性病例，该患者在宫颈细胞学采样后因阴道上行性GAS感染而发生STSS。患者主诉有阴道分泌物，为此她接受了妇科检查并进行了阴道采样。第二天，出现腹泻和呕吐。7天后，她因感染性休克入住我院。怀疑有坏死性小肠结肠炎并进行了手术干预；然而，患者被诊断为原发性腹膜炎并开始使用抗生素。第2天，血培养怀疑有GAS，考虑到STSS更换了抗生素。第4天，在血液、腹水和阴道拭子标本中确诊为GAS，并诊断为由阴道上行性GAS感染引起的STSS。本病例报告表明，宫颈细胞学采样检查阴道分泌物后可能发生STSS。如果女性出现不明原因的感染性休克，尤其是伴有肠胃炎症状时，应考虑将STSS作为鉴别诊断。
